Order your own labs to monitor your health

Curious about your cholesterol level? Could you be pregnant? Is your blood glucose stable?

The answers to these questions are just a lab test away. And you don't have to go to your doctor to get them. For several years now, both Riverside Health System and Sentara Healthcare have been offering the service under the respective labels Direct Access Lab Testing, or DALT, and Sentara SelfTest. Last month, Sentara made access even easier by adding the ability to register, request and pay for the tests online.

The straightforward approach to do-it-yourself test-ordering includes a flat fee for each test, which must be paid for out-of-pocket. Unlike tests ordered by a physician, these are not eligible for insurance coverage. Costs range from around $10 for a glucose screen up to $45 for a thyroid stimulating hormone test, with most falling somewhere in between.

They're appropriate not only for those monitoring a chronic condition, but also for people looking for one-time information.

"Diabetics may be monitoring their glucose. Others might be taking anti-coagulants, such as Coumadin, and need to monitor prothrombin and INR once a week, or once a month, or they might be traveling," said Lynn Onesty, administrative director of lab services for Riverside. "A high volume gets pregnancy results. They might have done the over-the-counter and want more of a confirmation."

There's no way to make a direct cost comparison to using a doctor's order, as differences in individual insurance coverage determine costs. Onesty added, though, that direct access can benefit uninsured self-pay patients sent by their doctors. During the registration process, if it becomes apparent that they might have trouble paying, an alternative arrangement can be made. "Sometimes we're able to offer lab testing at a reduced cost," she said, citing lower overhead costs in bypassing insurance reimbursement.

Beth Deaton, Sentara's director of Consolidated Laboratory Services, echoed the economic benefits of self-ordered tests. "It's a cash-and-carry business. It's less expensive to run," she said. "If a physician wants them to have the test and they're either uninsured or underinsured, we can charge them less." Utilization is slowly increasing, but Sentara SelfTest still expects to do about 4,275 "units of service," or tests, this year.

At Riverside Regional Medical Center in Newport News, walk-ins for the lab — usually only one a day — go to the "draw center" where literature explains in detail the different tests and their purpose. Any specimens they provide are then walked down the hall to the lab, which has been fully automated since 2010. With the vial tucked into a "puck" on an assembly line, bar code readers determine which instrument accesses it and which tests are performed. For example, a "basic metabolic panel" involves eight tests and provides information on electrolytes, sodium, potassium, chloride, CO2, glucose, BUN and creatinine. "It operates 24/7," said Lisa Ballou, technical manager for the lab, where a refrigerator can store up to 3,000 specimens for several days after analysis.

Test results go direct to the patient, who must come in person with the appropriate I.D. to pick them up between 24 and 48 hours later. The results can also be sent to a physician for a $2 charge. Though the number of tests is limited — there are now 18 options — they account for most of those ordered, Onesty said. Those recently added to the lineup include checking vitamin D levels and hemoglobin A1C, a long-term glucose measure important to diabetics. "If we have what we call a 'critical value,' we ask them to contact a physician ASAP or direct them to the Riverside Nurse program, who can also direct them to a provider. It's a very rare occurrence," said Onesty.

Sentara SelfTest sends all its lab tests from draw sites throughout Hampton Roads to Sentara Reference Laboratory at Sentara Norfolk General Hospital. The lab, which is also used by some out-of-network hospitals for complex tests, is accredited by the College of American Pathologists, the Virginia Department of Health and the Joint Commission of Healthcare Organizations. By going digital last month, consumers can now order their tests and pay for them online, filling out all the paperwork before heading to a draw site.

"The digital option offers added convenience and privacy for consumers," said Deaton. Those who prefer can still pick up the paperwork at outpatient pharmacy counters at Sentara hospitals, fill out the forms and pay, then take the paperwork to a draw site.

Most tests do not require fasting or special precautions. The exception is the complete lipid profile that requires patients to fast for 10 to 14 hours prior to testing in addition to not drinking coffee. Sentara reports that the busiest time at its "draw centers" is before 10 a.m., so those who don't need to fast are encouraged to come after that time.

It offers 20 tests in all, from a "complete metabolic panel" and PSA (prostate specific antigen) to triglycerides, vitamin D and glucose. The results are mailed direct to the patient, typically within 24 hours. If any results are critical, a physician contacts the patient directly by phone. For those with an electronic health record at Sentara My Chart, the test results are automatically transmitted into their medical record.

Salasky can be reached by phone at 757-247-4784.

Want tests?

Here are some selected walk-up sites to receive testing; its' advisable to check the operating times in advance: